Morbidity and predictors of mortality in nonagenarians undergoing emergency surgery

Background: Data on perioperative outcomes in nonagenarians remain limited.Objective: The objective of the study was to evaluate morbidity and short-and mid-term mortality in nonagenarians undergoing emergency non-cardiac surgery and to identify predictors of 6-month mortality.Material and methods: We conducted a retrospective single-center cohort study including all patients aged ≥ 90 years who underwent emergency non-cardiac surgery.Demographic variables, comorbidities, surgical characteristics, post-operative complications (Clavien-Dindo), and mortality (in-hospital, 30-day, and 6-month) were recorded.Logistic regression was used to identify predictors of 6-month mortality.Results: Among 4,192 emergency procedures, 106 patients (2.5%) were nonagenarians.Mean age was 92.8 ± 2.6 years, and 74.4% were female.Most patients (95.2%) had ≥ 2 pre-operative comorbidities; the mean Charlson comorbidity index (CCI) was 6.5 ± 1.6.Post-operative complications occurred in 83% of patients.In-hospital mortality was 6.5%, increasing to 9.3% at 30 days and 33.9% at 6 months.Higher CCI, presence of ≥ 2 comorbidities, non-orthopedic surgery, and general anesthesia were associated with increased 6-month mortality.Conclusions: Emergency surgery in nonagenarians was associated with high morbidity and substantial 6-month mortality.Long-term survival appeared more closely related to baseline comorbidity burden and frailty than to immediate surgical factors.